Provider Demographics
NPI:1144390683
Name:PRIMARY CARE HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:PRIMARY CARE HEALTH SERVICES, INC.
Other - Org Name:BRADDOCK FAMILY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILFORD
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-244-4700
Mailing Address - Street 1:7227 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15208-1814
Mailing Address - Country:US
Mailing Address - Phone:412-244-4700
Mailing Address - Fax:412-244-4992
Practice Address - Street 1:404 BRADDOCK AVE
Practice Address - Street 2:
Practice Address - City:BRADDOCK
Practice Address - State:PA
Practice Address - Zip Code:15104-1804
Practice Address - Country:US
Practice Address - Phone:412-351-6300
Practice Address - Fax:412-351-6500
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIMARY CARE HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-09
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA391915Medicare Oscar/Certification
PA391915Medicare PIN